糖尿病肾脏疾病透析患者肌钙蛋白T水平的变异及临床价值分析
Variability and clinical value of troponin T levels in diabetic kidney disease patients treated with di-alysis
于瑞 1程翠翠 2张珊 2杨晓霞 2孙馨宇 2高庆贞2
作者信息
- 1. 山东第二医科大学临床医学院,潍坊 261042
- 2. 山东省济南市中心医院肾内科,济南 250013
- 折叠
摘要
目的 明确肌钙蛋白T(troponin T,TnT)在糖尿病肾脏疾病(diabetic kidney disease,DKD)透析患者中的变异情况,评价TnT对DKD透析患者的临床价值.方法 对2014年1月1日至2020年8月31日山东省济南市中心医院8553例透析患者及其TnT值进行筛选,依据患者的纳入与排除标准筛除5692例,排除不符合TnT入选标准者2485例,最后入选376例患者.入选患者根据原发疾病分为DKD透析组和非糖尿病肾脏疾病(non-diabetic kidney disease,NDKD)透析组,比较2组患者TnT基线水平的差异,并采用受试者工作特征曲线确立诊断急性心肌梗死的最佳阈值,进一步分析DKD透析患者TnT基线的影响因素及与预后不良的关系.结果 DKD透析组患者TnT基线水平(267.27 ng/L)明显高于NDKD透析组患者(76.09 ng/L),是NDKD透析组的3.51倍;NDKD透析组患者诊断急性心肌梗死的最佳阈值为166.85 ng/L,DKD透析组患者的最佳阈值为367.45 ng/L;DKD透析组中男性的TnT基线水平高于女性,TnT基线水平与年龄、糖尿病视网膜病变程度、下肢血管病变程度呈正相关,与血红蛋白、白蛋白呈负相关.随着TnT基线水平逐级递增,DKD透析组患者心肌梗死率、心因性病死率、糖尿病足部溃疡率、全因死亡率也逐级升高.结论 DKD透析组患者的TnT基线水平明显高于NDKD透析组患者,且诊断急性心肌梗死时需要更高的阈值.TnT基线水平升高受糖尿病血管并发症等因素影响,可作为不良事件的预后指标.
Abstract
Objective To determine the variation of troponin T(TnT)in diabetic kidney dis-ease(DKD)patients treated with dialysis,and to evaluate its clinical value.Methods A total of 8,553 DKD patients treated with dialysis and examination of TnT values were screened in Jinan Central Hospi-tal from January 1,2014 to August 31,2020.Screened by inclusion and exclusion criteria,5,692 pa-tients were excluded.After excluding 2,485 cases with unavailable TnT data,finally,376 eligible pa-tients were included into our study.They were divided into DKD dialysis group and non-DKD(NDKD)dialysis group based on the primary disease.Baseline TnT was compared between the two groups,and the optimal threshold to diagnose acute myocardial infarction was determined by plotting the receiver oper-ating characteristic(ROC)curves.Influencing factors for baseline TnT in DKD patients treated with di-alysis and their correlation with poor prognosis were analyzed.Results Baseline TnT in the DKD dialy-sis group(267.27 ng/L)was significantly higher than that in the NDKD dialysis group(76.09 ng/L),which was 3.51 times higher.The optimal threshold of baseline TnT for the diagnosis of acute myocar-dial infarction was 166.85 ng/L in NDKD dialysis group,and 367.45 ng/L in DKD group.Higher base-line TnT were detected in men than women in the DKD dialysis group.Baseline TnT was positively as-sociated with age,degree of DKD,and degree of lower extremity vasculopathy,but negatively corre-lated with hemoglobin and albumin.With the increase in baseline TnT,the rate of myocardial infarction,psychogenic mortality,diabetic foot ulcer,and all-cause mortality increased in DKD dialysis group.Con-clusion Baseline TnT is significantly higher in the DKD dialysis group than that of the NDKD dialysis group,and a higher threshold is required for the diagnosis of acute myocardial infarction.Elevated base-line TnT level is influenced by factors such as diabetic vascular complications,which can be used as a prognostic indicator for adverse events.
关键词
糖尿病肾脏疾病/肌钙蛋白T/心肌梗死/影响因素/预后不良Key words
Diabetic kidney disease/Troponin T/Myocardial infarction/Influencing factor/Poor prognosis引用本文复制引用
出版年
2025
NETL
NSTL
万方数据